Inside Health

St. Vincent's To Expand Trauma Unit For New Age

By RICHARD PÉREZ-PEÑA

Published: September 1, 2004

When the jets struck the World Trade Center, the flood of wounded survivors was far smaller than expected, but even so, hospital officials around New York City found that they were ill-prepared for the large number of casualties they could face in an age of terrorism.

Nowhere was the message clearer than at St. Vincent's Hospital Manhattan, at Seventh Avenue and West 12th Street. The hospital's already overloaded emergency room, which is Lower Manhattan's only trauma center, treated more than 800 injured from the trade center. Since then, St. Vincent's, like its counterparts around the city, has invested in tools like decontamination showers and biohazard suits.

And today, former Mayor Rudolph W. Giuliani and his wife, Judith, are to break ground on a new $25 million trauma center at St. Vincent's that will bear his name, the first large expansion of trauma treatment facilities in the city since the trade center attack.

Mrs. Giuliani is executive director of the hospital's campaign to raise $100 million through private donations for a wide array of improvements, including this one, and Mr. Giuliani has also raised money for St. Vincent's.

''One of our great concerns on Sept. 11 was that we might not have enough hospital capacity, and if it were biological or chemical, then we would really have been strained,'' Mr. Giuliani said in an interview yesterday. ''Downtown Manhattan is the third-largest business district in the country, and if you ever needed to get people into units that deal with biological and chemical attacks, you need a trauma center of this kind in Lower Manhattan.''

The project, to be completed in stages over three years, anticipates such unconventional emergencies. St. Vincent's says it will have the first emergency department in the city in which the air pressure in every room can be lowered, so that germs and chemicals do not escape.

The hospital's officials say the project is intended to address day-to-day needs, at least as much as the catastrophic. The emergency department now handles nearly twice as many patients as it was designed for, in the 1980's. Manhattan's East Side has one of the world's great concentrations of hospitals, but on the West Side, St. Vincent's is the only hospital between the Battery and the West 50's.

''If you walk in at 4 o'clock on any given day, every cubicle is taken and we have patients waiting in the hallways,'' said Maggie N. Smith, the department's nurse manager.

The department will more than double in space, to 23,000 square feet, in part by pushing the Seventh Avenue and 11th Street walls of the building outward. The number of beds will rise to 46 from 28, and each bed will have its own room. Technological improvements will include cardiac monitoring equipment at every bedside, up from the 10 beds that have it now; a CAT scanner in the department so that patients do not have to be sent to another floor for scans; and a computer system that will allow doctors to call up patient charts and scans on bedside screens.

While nearly every hospital has an emergency room, only a few are designated as Level One trauma centers, meaning that they have an array of specialists on duty at all hours, to handle the most serious emergencies.

The St. Vincent's project extends what seems a paradox of New York's hospitals, that even as their daily census has declined and they have hemorrhaged money, they continue to build. Hospital executives insist there is no contradiction, because the additions are financed by private contributions and are needed to remain competitive.

Hospitals have mostly added features like cancer or cardiac care centers that are seen as profit-makers, or attractive children's wings and maternity wards that do not make money directly but can generate business over all by appealing to patients. Much rarer are the projects, like St. Vincent's trauma center, an overhaul of Bellevue Hospital Center's trauma center in the 1990's, or Bellevue's recent expansion of its intensive care unit, that are not viewed as potential money-makers.